Introduction: Recent studies showed that patients with chronic heart failure with recovered ejection fraction (HFrecEF) have better clinical outcomes than those with preserved ejection fraction (HFpEF). However, there is lack of data about HF prognosis according to EF change in acute heart failure (AHF). Therefore, the aim of this study was to investigate the prognosis of HFrecEF compared to HFpEF in patients with AHF.
Methods: A total of 5,625 cohort patients with AHF enrolled in Korean AHF registry (KorAHF). Of them, 2,632 patients underwent follow-up echocardiography with measurement of EF. They were divided into three groups according to EF change: HF with reduced EF (HFrEF) (n=1,522, 68.6±14.5 years, 818 males), HFpEF (n=281, 72.6±13.5 years, 115 males), and HFrecEF (n=829, 67.6±14.2 years, 341 males). HFrEF was defined as AHF patients with EF <50%, HFpEF as EF >=50%, and HFrecEF as EF>=50% with previous EF <50%. Primary end-point was all-cause mortality at 1-year follow up.
Results: Patients were older (72.6±13.5 vs. 67.6±14.2 vs. 68.6±14.5 years, p<0.001) and more likely to be female (59.1% vs. 41.1% vs. 46.3%, p=0.058) in HFpEF group than in HFrecEF and HFrEF group. Systolic BP was lowest (136.7±31.1 vs. 128.6±29.9 vs. 131.9±29.7 mmHg, p<0.001) in the HFrecEF group. In echocardiographic exam, EF was lowest in the HFrecEF group (60.0±6.4% vs. 30.4±10.1% vs. 37.8±15.8%, p<0.001) and E/e’ was highest (18.7±10.9 vs. 22.0±12.0 vs. 21.2±11.3, p<0.001). Ischemic etiology was less evident in the HFpEF group (22.1% vs. 40.0% vs. 39.0%, p<0.001), but valvular (29.5%), hypertensive (6.8%), and tachycardic etiologies (12.8%) were more frequent in the HFpEF group. In clinical outcomes, 1-year death was highest in the HFrecEF group (13.9% vs. 18.3% vs. 16.6%, p=0.752) and rehospitalization rate was comparable between the groups (42.7% vs. 41.9% vs. 45.5%, 0.141). Kaplan-Meier survival analysis showed that 1-year mortality in the HFrecEF group was marginally higher than that in the HFpEF group (p=0.046 by log rank test).
Conclusions: AHF patients in HFrecEF group had higher mortality than those in HFpEF group. Recovery from acute depressed LV function may not always warrant favorable clinical outcomes in long-term follow-up.